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Doctors, nurses and medical students march to the Tornillo Port of Entry on June 23, 2018 in Tornillo, Texas, to demand an end to separation of immigrant children from their parents. - The Trump administration's erecting of a tent city to house minors separated from their parents has drawn sharp criticism, and is still under fire, despite President Trump's executive order to stop family separation. (Photo by Paul RATJE / AFP)

American medical care is currently in shambles. Compounding the difficulties surrounding our fractured system is the issue of how immigrants receive appropriate healthcare.

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In this time of rising health insurance plans and high deductibles, with the future of the ACA repeal hanging in the Senate’s hands, imagine if you could bypass insurance altogether. What if you could pay your doctor a monthly fee for basic care much like a gym membership? While that may sound like a dream lost to the innocence of the 1950s, a small but growing percentage of U.S. physicians are resurrecting a model of direct pay primary care that provides better patient access with a greater focus on quality of care. It’s driven in large part by physician frustration with third-party payers and overloaded panels, as well as consumer frustration with long waits and high co-pays to see doctors for simple issues.

The concept works like this: Instead of taking insurance, your doctor would charge you a monthly or yearly membership fee for basic visits, tests and medications. For the patient, this means no surprise out-of-pocket expenses; getting seen more quickly and more often, if necessary; and a better relationship with one’s physician. For doctors, this model means they no longer have to take on more patients than they can handle, fewer third-party payment system hassles, the luxury of seeing fewer patients at their own schedule, with greater focus on the patient relationship. Of course, it does not cover catastrophic care, such as hospitalization, or treatment for diseases like cancer, and it may not meet the needs of older and disabled people who traditionally rely on Medicare and Medicaid.

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Co-sleeping, sleep training, breast versus bottle, free-range versus helicopter parenting – these are all hot-button parenting issues. But no parenting issue invokes more division and derision than vaccination.

The difference, pro-vaccinators argue, between the first examples and vaccination is that the decision not to vaccinate impacts more than just one’s immediate family. Unvaccinated children can present a health risk to those too young to be immunized or who are unable to receive vaccines because of allergies or other health issues.

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